Anti-ganglioside antibody positive neuromyelitis optica spectrum disorders with peripheral neuropathy: a case report

Abstract

Background: Neuromyelitis optica spectrum disorders (NMOSD) is a group of autoimmune-mediated disorders of the central nervous system primarily involving the optic nerve and spinal cord. There are limited reports of NMOSD associated with peripheral nerve damage.

Case presentation: We report a 57-year-old female patient who met the diagnostic criteria for aquaporin 4 (AQP4)-IgG positive NMOSD with undifferentiated connective tissue disease and multiple peripheral neuropathy. In addition, the patient was positive for multiple anti-ganglioside antibodies (anti-GD1a IgG antibodies and anti-GD3 IgM antibodies) and anti-sulfatide IgG antibodies in serum and cerebrospinal fluid. After treatment with methylprednisolone, gamma globulin, plasma exchange, and rituximab, the patient's status improved and was subsequently discharged from our hospital.

Conclusions: The neurologist should be aware of the unusual association between NMOSD and immune-mediated peripheral neuropathy undifferentiated connective tissue disease and nerve damage mediated by multiple antibodies may have combined to cause peripheral nerve damage in this patient.

Keywords: Anti-ganglioside antibody; Neuromyelitis optica spectrum disorders; Peripheral neuropathy; Undifferentiated connective tissue disease.

Fig. 1

MRI findings of cervical cord. A and B Prior to treatment, MRI showed myelopathyfrom medulla oblongata to spinal cord C3; C and D MRI reexamination showed that the range of myelopathy was enlarged to spinal cord C5. White arrow indicates the lesion. A and C are T2-weighted images, while B and D are T1-weighted images